Background Handball is one of the most traumatic Olympic sports, with a growing number of participants. Large sample size epidemiological studies across various playing levels are lacking in this sport.

Objective To determine injury incidence over one season of the French championship and according to sex, level of play and time schedule as well as the most common injury locations.

Design Prospective total cohort study.

Setting French Handball championship over the whole 2016–17 season.

Participants 323 628 amateur and professional French handball players.

Interventions The injuries that occurred during matches of the French handball championship were recorded by the officials of each team with the help of a specific medical questionnaire of the electronic match report.

Main Outcome Measurements The number of injuries as well as injury rate expressed per 1000 Athlete Exposure (AE). The relative risks (RRs) were calculated and compared across the different categories.

Results 78 147 TE were recorded from the 202 394 official championship matches. The overall incidence was 23.5 TE/1000AE. Incidence rate was higher for national-level players (RR=1.22; CI 95% 1.19 to 1.25) compared to regional level, and 1.52 (CI 95% 1.50 to 1.54) at regional level compared to county level. Males were at lower risk of injury (RR=0.78; CI 95% 0.77 to 0.79). Three main injury incidence peaks were observed (October, February and April) corresponding to the academic holidays. The most common injury locations were Foot/Ankle (19.8%), Knee (15.5%), Hand/Wrist (15.2%) and Head/Neck (14.6%).

Conclusions Handball is a sport with a high injury rate during matches, especially among female players from high level of play. The scheduling of matches during the season also appears to influence the number of injuries. Electronic databases could be considered as a promising tool to assess injury distribution in the context of epidemiological studies and sports prevention.